Mental Health Chapter 16, 22

Physical effects of chronic alcohol use disorder

cardiomyopathy esophagitis esophageal varices pancreatitis hepatitis Wernicke-Korsakoff syndrome Leukopenia Thrombocytopenia

obsessive-compulsive

disciplined perfectionistic efficient organized inflexible

avoidant

evasive afraid of rejection mistrustful awkward hypersensitive withdrawn

antisocial

intimidating callous cold charming exploitive thrill seeking manipulative

paranoid

irritable mistrustful suspicious hypervigilant oversensitive vindictive

A nurse working in an inpatient psychiatric setting is most likely to encounter which of the following personality disorders? Select all that apply. Dependent Borderline Histrionic Avoidant Antisocial

Borderline Histrionic Antisocial

Opioids and large doses of anxiolytics tend to have the same effects on the body. Which one(s) do they have in common? Select all that apply. Mood changes Drowsiness Hypertension Euphoria Respiratory depression

Drowsiness Respiratory depression

Effects of opioid use disorder

Euphoria Drowsiness Respiratory depression Hypotension Mood changes All opioids affect the CNS, causing euphoria, mood changes, mental clouding, drowsiness, and pain reduction. Pupillary constriction occurs in response to the stimulation of the oculomotor nerve, and CNS depression of the respiratory centers within the medulla results in respiratory depression. Nausea and vomiting commonly associated with opiate ingestion are related to the stimulation of the centers within the medulla that trigger this response. There is a marked decrease in the movement of food through the GI tract and constipation may be a serious problem. At high doses, opioids induce hypotension, which may be caused by direct action on the heart or by opioid-induced histamine release. Opioid use causes decreased sexual function and diminished libido, and long-term use has been associated with erectile dysfunction.

Patients with dependent personality disorder exhibit which of the following symptoms? Select all that apply. Socially anxious Fear of separation Passive Afraid of rejection Lack of self-confidence

Fear of separation Passive Lack of self-confidence

During group Debbie takes over to talk about her problems regarding the boyfriend who just broke up with her and then begins to flirt with the men in the session and asks them about how pretty she looks today. Which diagnosis is most consistent with Debbie's presentation of symptoms? Narcissistic Histrionic Antisocial Borderline Submit

Histrionic

Which of the following are predisposing factors to substance use disorders? Select all that apply. Modeling Depression Peer pressure Genetics Irrational thinking patterns

Modeling Depression Genetics Irrational thinking patterns

The nurse is assessing a patient who presents as very organized, disciplined, and efficient, but is also inflexible and perfectionistic. Which diagnosis best fits the description of this patient? Dependent Avoidant Narcissistic Obsessive-compulsive

Obsessive-compulsive

antisocial

People with antisocial personality disorder show a pervasive pattern of disregard for others and may have a history of violating the rights of others since the age of 15 years, as indicated by 3 or more of the following: failure to conform to social norms with respect to lawful behaviors; deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure; impulsivity or failure to plan ahead; irritability and aggressiveness; reckless disregard for the safety of self or others; consistent irresponsibility; and lack of

Dependent

People with dependent personality disorder have a pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation. They also have difficulty making everyday decisions without an excessive amount of advice and reassurance from others, need others to assume responsibility for major areas of their life, and have difficulty expressing disagreement with others because of fear of loss of support or approval. There is also difficulty initiating projects or doing things on their own because of a lack of self-confidence and going to excessive lengths to obtain nurturance and support. The person feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for self, urgently seeks another relationship when a close relationship ends, and is unrealistically preoccupied with fears of being left to take care of self.

Symptoms in phases of alcohol use disorder

Phase 1 - tolerance begins to develop Phase 1 - alcohol is used to relieve everyday stress Phase 2 - blackout occur Phase 3- periods of binge drinking Phase 4- feels helpless and depressed Phase 4 - withdrawal symptoms occur when not drinking Phase 1 is the prealcoholic phase, characterized by the use of alcohol to relieve the everyday stress and tensions of life. Tolerance develops and the amount required to achieve the desired effect steadily increases. Phase 2 is the early alcoholic phase, which begins with blackouts (brief periods of amnesia that occur during or immediately following a period of drinking) and ends with sneaking drinks or secret drinking, preoccupation with drinking and maintaining the supply of alcohol, rapid gulping of drinks, and further blackouts that lead to feelings of enormous guilt. Phase 3 is the crucial phase where the person has lost control of use, physiological addiction is evident, and binge drinking lasting from a few hours to several weeks is common. The person usually experiences loss of job, relationships, and family in this phase. Phase 4 is the chronic phase, characterized by emotional and physical disintegration, helplessness, self-pity, depression, suicidal ideation, life-threatening physical manifestations, and unmanaged withdrawal, which can be fatal.

Fetal alcohol syndrome characteristics and behaviors

Problems with memory Poor coordination Poor reasoning Learning disabilities Language delays Fetal alcohol syndrome includes physical, mental, behavioral, and learning disabilities with lifelong implications. The person may have problems with learning, memory, attention span, communication, vision, hearing, or a combination of these. Other characteristics include abnormal facial features, small head size, shorter-than-average height, low body weight, hyperactive behavior, difficulty in school, intellectual disability or low IQ, sleep and sucking problems as a baby, and problems with the heart, kidneys, or bones.

Characteristics of codependency

Relinquishes personal identity Never feels good enough Feels responsible for fixing problems of others Forgoes own need to take care of others Codependency describes the dysfunctional behaviors seen among family members and loved ones of the person with a substance use disorder. The codependent person is able to achieve a sense of control only through fulfilling the needs of others. As a result, codependency has been called "a dysfunctional relationship with oneself." Characteristics of the codependent person include taking care of others at the expense of one's own needs, feeling responsible for fixing other people's problems, having low self-esteem, expecting to perform perfectly but never feeling adequate, desperately seeking approval from others, often identified as "people pleasers," and generally unhappy and seeking to fulfill unmet needs by looking outside oneself. Individuals who have codependency tend to come from dysfunctional families with a history of abuse or neglect. With this disorder, weak boundaries lead to feelings of resentment, lack of trust, and anger toward others.

Effects of large doses of sedative, hypnotic, and anxiolytic drugs

Respiratory depression Drowsiness Decreased body temperature Hypotension The sedative, hypnotic, and anxiolytic compounds induce an overall general depressant effect, and large doses may affect other organ systems. The use of these substances decreases the amount of sleep time spent dreaming. They are capable of inhibiting the reticular activating system, resulting in respiratory depression that may lead to lethal overdose. These drugs can also cause hypotension, may reduce urine output, can greatly decrease body temperature, and often cause sexual dysfunction.

schizoid

Schizoid personality disorder is manifested by lack of desire for or enjoyment from close relationships, almost always chooses solitary activities, takes pleasure in few, if any, activities, and is indifferent to praise or criticism. The person also shows little interest for sexual contact, lacks close friends or confidants, and shows emotional coldness, detachment with flattened affect.

A patient is in the recovery room after an emergency surgery. The nurse is assessing the patient and observes a flat affect, some bizarre behaviors with odd beliefs, suspiciousness, and tangential speech. What diagnosis would be most appropriate for this patient? Paranoid Schizoid Schizotypal Antisocial

Schizotypal

schizotypal

Schizotypal personality disorder is the most closely related to schizophrenia. The person with schizotypal personal disorder experiences ideas of reference, has odd beliefs not shared by subculture (such as "sixth sense"), and has unusual perceptual experiences such as illusions. This individual also has odd or eccentric behavior or appearance, odd thinking and speech, inappropriate or constricted affect, and suspiciousness. They lack close friends or intimate others and have excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self.

A nurse is assessing a patient who presents to the emergency department with a history of blackouts, has been binge drinking, and was just expelled from college. Which phase of drinking with alcohol use disorder is this client in? The Crucial Phase The Chronic Phase The Prealcoholic Phase The Early Alcoholic Phase

The Crucial Phase

Which of the following nursing implications arises from the fact that the majority of individuals with a substance use disorder have a dual diagnosis of mental illness? The nurse will approach the patient from an integrated health-care model and tailor the care plan to address both the psychiatric and substance use diagnoses. The nurse knows that a substance use disorder will always exacerbate a psychiatric diagnosis, so it must be treated first. The nurse will address the psychiatric diagnosis first as it preceded the development of the substance use disorder. The nurse will ensure that any psychiatric diagnoses are identified and resolved before substance use disorder treatment.

The nurse will approach the patient from an integrated health-care model and tailor the care plan to address both the psychiatric and substance use diagnoses.

avoidant

The person with avoidant personality disorder presents a pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation; avoids occupational activities that involve significant interpersonal contact because of fears of criticism, disapproval, or rejection; and is unwilling to get involved unless certain to be liked. They usually show restraint within intimate relationships because of fear of being shamed or ridiculed, are preoccupied with being criticized or rejected in social situations, and are inhibited in new interpersonal situations because of feelings of inadequacy. This person views self as socially inept, personally unappealing, or inferior to others and is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing.

borderline

The person with borderline personality disorder displays a pervasive pattern of instability of interpersonal relationships, self-image, and affect, and marked impulsivity beginning by early adulthood. This is displayed through frantic efforts to avoid real or imagined abandonment; a pattern of unstable and intense interpersonal relationships (idealization and devaluation); identity disturbance; impulsivity in two or more areas that are potentially self-damaging; recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior; affective instability due to marked reactivity of mood; chronic feelings of emptiness; inappropriate, intense anger or difficulty controlling anger; and transient, stress-related paranoid ideation or severe dissociative symptoms.

paranoid

The person with paranoid personality disorder expects (without sufficient basis) exploitation, harm, and deception from others, has unjustified doubts about the loyalty and trustworthiness of friends, and reads hidden meaning into benign remarks or events. This person persistently holds grudges, is reluctant to confide, perceives attacks on their character or reputation (not apparent to others) and quickly reacts with anger or a counterattack, and has recurrent, unjustified suspicions.

histrionic

Those with histrionic personality disorder have a pervasive pattern of excessive emotionality and attention seeking as indicated by being uncomfortable when not the center of attention, inappropriate sexually seductive or provocative behavior, rapidly shifting and shallow expression of emotions, and using physical appearance to draw attention to self. The individual may also have a style of speech that is excessively impressionistic and lacking in detail; shows self-dramatization, theatricality, and exaggerated expression of emotion; is suggestible; and considers relationships more intimate than they actually are.

Narcissistic

Those with narcissistic personality disorder show a pervasive pattern of grandiosity, need for admiration, and lack of empathy, beginning by early adulthood. This is manifested by a grandiose sense of self-importance; a preoccupation with fantasies of unlimited success, power, brilliance, or beauty; and a belief that they are "special" and unique and can only be understood by, or should associate with, other special or high-status people (or institutions). These individuals may also require excessive admiration, display a sense of entitlement, be interpersonally exploitive, lack empathy, be envious of others or believe that others are envious of them, and show arrogant, haughty behaviors or attitudes.

schizoid

aloof isolated no desire for relationships cannot experience pleasure indifferent to others flat affect

substance use disorder predisposing factors

culture and ethnicity conditioned response role modeling genetics depression punitive superego irrational thinking patterns Many factors have been implicated in the predisposition of substance use, but no single theory adequately explains the problem. Overall, research estimates that genetics account for 40% to 60% of a person's vulnerability. There is also good evidence that changes in brain structure and brain neurochemistry occur in the process of developing an addiction, but whether these changes wholly explain etiology remains controversial. The psychodynamic approach to the etiology of substance use focuses on a punitive superego and fixation at the oral stage of psychosexual development where the person turns to drugs to diminish unconscious anxiety and increase feelings of power and self-worth. Certain personality traits (low self-esteem, frequent depression, passivity, antisocial personality traits, the inability to relax or to defer gratification, and the inability to communicate) have been associated with an increased tendency toward addictive behavior. Irrational thinking patterns (denial, projection, and rationalization) have long been identified as a central problem in addiction. The effects of modeling, imitation, and identification on behavior can be observed from early childhood. An individual is more likely to use substances if their parents provide a model for substance use. Many substances create a pleasurable experience that encourages the user to repeat it; thus, the reinforcing properties of addictive substances "condition" the individual to repeatedly seek out use. Factors within culture help establish patterns of substance use by molding attitudes, influencing patterns of consumption based on cultural acceptance, and determining the availability of the substance.

narcissistic

exaggerated self-worth lack of empathy superior exploitive lack of humility exploitive

schizotypal

illusions bizarre behaviors ideas of reference tangential social anxiety flat affect aloof depersonalization

dependent

lack of self-confidence passive helpless when alone clingy low self-worth

histrionic

manipulative dramatic extroverted seductive attention-seeking

borderline

mood swings clinging and distancing state of crisis impulsive splitting manipulative self-destructive behaviors intense interpersonal relationships

diagnostic criteria of substance use disorder

withdrawal tolerance risky use cravings control recurrent use People are considered to have a substance use disorder when they have a problem in the four domains of impaired control, social impairment, risky use, and pharmacological criteria. Substance use interferes with the ability to fulfill role obligations at work, school, or home. Often, the person would like to control the use of the substance, but attempts to do so fail and use continues to increase. Intense cravings lead to excessive time spent trying to procure more of the substance or recover from the effects of its use. Use causes problems with interpersonal relationships, and the individual may become socially isolated. Individuals with substance use disorders often participate in hazardous activities when they are impaired by the substance, and they continue to use the substance despite knowing that use contributes to a physical or psychological problem. Addiction is evident when pharmacological criteria (tolerance and withdrawal) develop.